A nation priding itself on medical advances has taken a major step backward. US measles cases, which have accelerated in recent weeks, have now reached a new post-elimination high, at 695 infections, the Centers for Disease Control and Prevention (CDC) said yesterday.
It's the nation's highest total in 25 years. And it's not even May.
Measles was declared officially eliminated in 2000 in the United States after total cases didn't even reach 140 for 3 straight years. The previous post-elimination annual high mark was recorded in 2014—for all of 2014—with 667 cases.
But you would have to go back to 1994, which saw 958 cases, for a more dismal record than this year's. The country, however, is on track to pass that total in the coming weeks.
Also today, the United Nations Children's Fund (UNICEF) spotlighted the global crisis of not vaccinating, as it noted that 21 million children globally miss out on measles-containing vaccine each year.
The cost of not vaccinating
Measles is not the benign disease that many who oppose vaccination might think. One in every four cases results in hospitalization, according to CDC data. As many as 1 in 20 children with measles also contract pneumonia, the most common cause of death from measles in young kids. And about 1 child in 1,000 suffers encephalitis, or inflammation of the brain, which can cause brain damage.
One or 2 of every 1,000 children infected with measles dies, even with the best of care, the agency said in its background information on the disease. Complications are most common in children under 5 years and adults older than 20.
Also, people might forget the devastating impact the disease had in the United States before the vaccine was developed in 1963. According to the CDC, 500,000 US cases annually were reported, resulting in 48,000 hospitalizations, 1,000 cases involving encephalitis, and 450 to 500 deaths.
Large outbreaks, misinformation
The record number of infections is largely the result of several large outbreaks: one in Washington state and two in New York that started in late 2018. One of them involves an Orthodox Jewish community in New York City that, as reported by state officials yesterday, has grown to 390 cases—more than half the US total.
"A significant factor contributing to the outbreaks in New York is misinformation in the communities about the safety of the measles/mumps/rubella vaccine," the CDC said today in a statement. "Some organizations are deliberately targeting these communities with inaccurate and misleading information about vaccines.
"CDC continues to encourage parents to speak to their family's healthcare provider about the importance of vaccination. CDC also encourages local leaders to provide accurate, scientific-based information to counter misinformation."
"This current outbreak is deeply troubling and I call upon all healthcare providers to assure patients about the efficacy and safety of the measles vaccine," said CDC Director Robert Redfield, MD. "And, I encourage all Americans to adhere to CDC vaccine guidelines in order to protect themselves, their families, and their communities from measles and other vaccine preventable diseases."
In a Health and Human Services (HHS) news release, HHS Secretary Alex Azar added, "With a safe and effective vaccine that protects against measles, the suffering we are seeing is avoidable. The CDC is ready to support public health departments in monitoring and responding to outbreaks, and will continue to receive, review, and compile the latest reports of measles cases."
The CDC also noted that the recent outbreaks started through importation, when travelers became infected in the growing number of countries that are experiencing widespread measles transmission, then infected people in the United States. The World Health Organization reported this month that global measles infections have increased 300% compared with the first 3 months of 2018, and measles is one of the most contagious diseases known.
Today, the California Department of Public Health (CDPH) urged all Californians, especially those traveling internationally, to be fully vaccinated against the disease. It also confirmed 38 measles cases in the state, an increase of 15 over last week's total and more than triple what state officials recorded at this point last year.
Travel to India, Cambodia, Thailand, Philippines, Vietnam, and the Ukraine has been tied to the California cases, the CDPH said.
Missed opportunities worldwide
In a press release yesterday, UNICEF said an estimated 169 million children from 2010 through 2017 have missed the first dose of measles vaccine, or 21.1 million per year on average.
"Widening pockets" of unvaccinated children have helped measles surge around the globe, the agency added. And the United States leads all high-income countries in children missing their first dose of measles vaccine, at 2.6 million over those 8 years. France was next, at 608,000, and Great Britain had 527,000.
"The ground for the global measles outbreaks we are witnessing today was laid years ago," said Henrietta Fore, UNICEF executive director. "The measles virus will always find unvaccinated children. If we are serious about averting the spread of this dangerous but preventable disease, we need to vaccinate every child, in rich and poor countries alike."
In addition to the surge in cases noted by the WHO, an estimated 110,000 people, most of them children, died from measles in 2017, a 22% increase from the year before, UNICEF said.
See also:
Apr 24 CDC media statement
CDC background information on measles complications
Apr 24 HHS news release
Apr 25 CDPH news release
Apr 24 CIDRAP News story "Measles in LA County, as 2 pregnant NYC women infected"
Apr 24 UNICEF press release
